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63 Cards in this Set
- Front
- Back
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What part of the bowel is usually involved with secretory diarrhea?
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The small bowel. This results in more watery diarrhea and is usually a toxin-mediated disease.
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What organisms result in secretory diarrhea?
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E. coli (ETEC, EAEC, EPEC), V. cholerae, Norovirus, Rotavirus, Cryptosporidium and other parasites
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How does V. cholerae and E. coli cause this secretory diarrhea?
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It secretes a toxin into the gut lumen that results in watery diarrhea.
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What is the epidemiology of diarrhea caused by ETEC and EAEC (traveler's diarrhea)?
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People that have traveled to different geographical areas can get this especially from travel to tropical areas. This is an extremely common problem among travelers. It is usually associated with consumption of contaminated food or water. You should assume ALL water is contaminated in developing countries. Fruits are a huge risk and even spicy foods.
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How much ETEC or EAEC is needed to cause diarrhea?
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A lot! These bacteria are acid sensitive so a large amount of bacteria is needed to cause disease.
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What is the epidemiology of Cholera?
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Massive epidemics have occurred due to a loss of sanitation with natural catastrophe's, wars, etc... This bacteria is spread by contaminated water and is not common in the US.
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How much Cholera is needed to cause diarrhea?
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A LOT! This is an acid-sensitive organism so a lot of bacteria is needed to cause disease.
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What are the symptoms and signs of ETEC and EAEC infection?
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Traveler's diarrhea:
Watery diarrhea with possible cramps and fever Not much nausea or vomiting It usually resolves in 3-5 days The severity of symptoms is due to how much bacteria you consume |
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What are the signs and symptoms of Cholera?
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You have an acute onset of watery diarrhea that smells sweet (rice water stool)
This disease is usually NOT associated with cramps, nausea, vomiting or fever Dehydration can occur quickly |
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What is the major danger of Cholera infection and what are some of the results of this?
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DEHYDRATION!
The patient can get orthostatic hypotension, tachycardia, lethargy, dry tongue, dry axillae, or tenting of the skin. It can lead to death. |
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What part of the GI tract do bacteria that cause inflammatory diarrhea target?
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Colon (predominantly the left side of the colon)
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What are the usual bacteria that cause inflammatory diarrhea?
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Clostridium difficle (becoming an increasing problem even in outpatient settings)
Campylobacter jejuni (most COMMON bacterial gastroenteritis in US) Shigella (causes more dramatic symptoms than Campylobacter) Entamoeba histolytic (parasite; uncommon but present in the US) |
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What is the MOST common cause of bacterial gastroenteritis in the US?
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Campylobacter jejuni
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How is Campylobacter spread and what types of disease does it cause (cases or outbreaks)?
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Campylobacter is most often gotten from poultry and sometimes from meat, dairy products, and water. It causes sporadic cases and not really outbreaks. It can be transmitted from puppies and kittens. Human-to-human spread is uncommon.
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How much of Campylobacter is needed to cause disease?
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A lot amount of bacteria is needed to cause disease because Campylobacter is acid-resistant. You need more than with Shigella though.
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How is Shigella transmitted?
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Shigella is transmitted from person-to-person through fecal-oral transmission. It can also be transmitted through food, water and fomites (inanimate objects or flies).
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What is associated with outbreaks of Shigella in the US?
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Wading pools and daycare
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How many Shigella bacteria are needed to cause disease?
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Very little. This bacteria is acid-resistance thus only a few bacteria are needed to cause disease.
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What are the symptoms and signs of Campylobacter?
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Cramps, fever, and diarrhea (small volume stools with blood and mucus OR watery stools). The diarrhea is inflammatory and you can see PMNs in the stool.
Patients are not as ill as they are when they have Shigella. |
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How long does Campylobacter last usually?
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One week (usually the patient is better before you can diagnose the cause of the disease)
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What are the symptoms and signs of Shigella infection?
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Cramps, fever, and frequent small volume bloody stools with mucus.
Tenesmus is common as well (pain when defecating). Some patients can have watery diarrhea and vomiting but this is NOT common. Patients LOOK SICK! This is a more severe disease than Campylobacter infection. |
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What are the conditions used to culture Campylobacter?
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Special media is used and it is incubated at a higher temperature than normal.
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How do you treat Campylobacter jejuni?
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Ciprofloxacin and rehydration.
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What organism causes Enterohemorrhagic E. coli infection?
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Shiga toxin producing E. coli O157 and other serotypes of EHEC.
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What did the strain of E. coli that caused an outbreak of Enterohemorrhagic E. coli infection have that made it special?
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Along with its ability to produce Shiga toxin, it obtained plasmids for antibiotic resistance and adhesins (it is known as Aggregative E. coli (EAEC)).
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What type of foods normally transmit EHEC?
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Beef, especially ground beef since it comes from MANY different cows.
Other foods are associated with outbreaks and their contamination is due to cows (example= apple cider made from apples that fell in cow manure). EHEC can be transmitted through water supplies and pools as well. |
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What does pasteurization do to E. coli?
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Kills it!
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How much EHEC is needed to cause disease?
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Not a lot! EHEC is an acid-resistant organism.
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Where was and what caused the latest outbreak of EHEC?
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Jimmy Johns Sprouts in the US
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What is the name of the disease EHEC causes?
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Gastroenteritis
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What are the symptoms and signs of Gastroenteritis (caused by EHEC)?
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Cramps, watery diarrhea, bloody diarrhea (in most people), and possible fever. People are not that sick and the disease goes away in a few days (self-limiting).
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Which side of the colon is usually infected by EHEC?
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The right side of the colon
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Is dehydration common with EHEC infection?
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NO
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What is the main complication with Gastroenteritis due to EHEC infection?
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Hemolytic uremic syndrome. This can lead to renal failure, thrombocytopenia, and hemolytic anemia. It is due to the Shiga toxin the organism produces.
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What virulence factor of EHEC causes Hemolytic Uremic syndrome?
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Shiga Toxin
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What are the 2 most common diseases caused by S. typhi and S. paratyphi?
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Enteric fever (typhoid fever) and a carrier state (they can infect individuals and remain persistent in the gallbladder and be transferred to other people via the stool).
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What are the 3 less common diseases associated with S. Typhi and S. paratyphi?
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Vascular infection (can lead to aortic aneurysms), Focal infections (can cause bacterimia) and gastroenteritis (the least common disease these pathogens cause).
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What is the most common disease caused by NON-typhi Salmonella?
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Gastroenteritis (NO enteric fever)
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What are the 3 less common diseases caused by non-typhi Salmonella species?
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Vascular infection (can lead to bacteremia), focal infections and a carrier state (uncommon)
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Is Salmonella a problem in the US?
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Yes and No. We hardly ever see Typhoid fever caused by Salmonella in the US but Gastroenteritis associated with Salmonella infection is common.
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How is S. typhi and S. paratyphi transmitted and who are its typical carriers and victims?
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There are ALWAYS human carriers of these bugs although the carriers are usually not ill. People can be carriers their entire lives. The bacteria can be spread through contaminated food and water including imported contaminated foods (mainly from Central America) and cooks with Salmonella coming from developing countries. A common victim are travelers.
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How much S. typhi and S. paratyphi are needed to cause disease?
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A lot! These organisms are acid-sensitive and thus a large amount of bacteria is needed to cause disease.
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How are non-typhi Salmonella transmitted and what are the most common bacterial species?
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Non-typhi Salmonella is usually carried by animals and thus is transferred via contaminated food such as eggs and poultry (MOST COMMON FOODS). The organism is transmitted to the CENTER of the egg and thus it must be FULLY cooked to kill the bacteria. Other ways it can be transmitted is by touching reptiles and amphibians which are frequently colonized (fecal-oral transmission).
The most common Salmonella species that cause enteric disease are S. typhimurium and S. enteritidus. |
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How much non-typhoid Salmonella is needed to cause disease?
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A lot! These organisms are generally acid sensitive.
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How can you prevent getting non-typhoid salmonella if you have pet reptiles and amphibians?
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WASH YOUR HANDS AND CLEAN YOUR PET CAGE!
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What are some examples of recent foods that have caused outbreaks of non-typhoid Salmonella disease in the US?
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Peanut butter, beef, poultry, hedge-hogs, mangoes, cantalopes, etc...
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What are the signs and symptoms of Gastroenteritis caused by non-typhi Salmonella?
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There is a huge variation in the type of diarrhea these organisms will cause (watery or not, bloody or not).
The patient MAY or MAY NOT have nausea, vomting, fever, cramps and look toxic. |
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What are the symptoms and signs associated with enteric fever caused by S. typhi or S. paratyphi?
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This is a systemic illness that is spread throughout the body. The patient has diarrhea at the beginning but this becomes constipation as the patient begins to get a fever and systemic symptoms begin to show up. The patient is VERY sick. They are lethargic, prostrate, toxic and septic.
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What are some other diseases and infections that can occur alongside enteric disease caused by S. typhi and S. paratyphi?
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The bacteria can cause focal infections in organs throughout the body resulting in complications such as meningitis, arthritis, osetomyelitis, endocarditis, etc...
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How do you diagnose S. typhi or S. paratyphi?
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Blood cultures since it is a systemic infection. Stool cultures could be used but the bacteria might not be present in the stool.
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What antibiotic is used to treat Enteric fever caused by S. typhi and S. paratyphi?
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Ceftriaxone
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How do you prevent diarrhea infections?
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Prevent fecal-oral spread (HAND HYGIENE)
ALWAYS eat beef, poultry and eggs cooked WELL-DONE Be careful about foods that contain raw eggs (Tiramisu, Cesar salad, homemade ice-cream, cookie dough, cheesecake) Prophylaxis Vaccines |
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What prophylaxis is done for diarrhea infections?
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Prophylaxis is not recommended but Ciprofloxacin is sent with a traveler so they can begin the antibiotic if they get ill. This can shorten the period of disease.
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What are the vaccines available to treat diarrhea infections?
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There are ONLY vaccines for Salmonella. there are 2 typhoid vaccines for S. typhi. One vaccine is an oral vaccine composed of live, attenuated bacteria that is taken in 4 doses over 2 weeks. It is 70% effective and induces local immunity. DO NOT give this to immunosuppressed patients. The second vaccine is an IM injection composed of Vi polysaccharide killed bacteria and is also 70% effective.
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What type of treatments are used for diarrhea infections?
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Fluid replacement is KEY for all diarrhea disease except enteric fever.
Antibiotics play a role depending on the bacteria you are dealing with. |
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What is the treatment for Traveler's diarrhea (ETEC infection)?
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Fluoroquinolones (ciprofloxacin) and fluids
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What is the treatment for Cholera infection?
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Fluids
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What is the treatment for Campylobacter infection?
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Fluoroquinolones but usually the disease resolves itself before the patient comes in
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What is the treatment for Shigellosis?
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Fluoroquinolones
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What is the treatment for Enterhemorrhaic E. coli infection (EHEC)?
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NO ANTIBIOTICS
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What is the treatment for Salmonella gastroenteritis?
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NO ANTIBIOTICS (it prolongs fecal carriage)
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What is the treatment for enteric fever (caused by S. typhi or S. paratyphi)?
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Fluoroquinolones or ceftriaxone. If you do not treat patients they will die.
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Which bacteria that cause diarrhea infections are causing problems due to increasing antibiotic resistance?
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Campylobacter (resistance bacterial strains are increasing in poultry due to the use of antibiotics in poultry)
Salmonella typhi Non-typhi Salmonella (Ceftriaxone and other antibiotic resistance is increasing due to the use of antibiotics in cows, pigs, etc...) Shigella |
